Prevention of Neural Tube Defects: Regional Policies in Folic Acid Enrichment and Supplementation

Background: The USA and Canada had already started an obligatory food fortification with folic acid in 1998; In 2009, Australia and New Zealand also started to do so. Methods: A survey was carried out among members of The European Consumers' Organisation (BEUC). Results: Most of the European countries go along with the recommendation of 200 mu g folic acid (or 400 mu g folic acid equivalents) for adults and 300 mu g (600 mu g) for pregnant women. To prevent neural tube defects, an additional supplementation of 0,4 mg folic acid is recommended for women before conception. So far, none of the European countries has implemented an obligatory folic acid enrichment of grain or other food, but this step is under discussion. Conclusion: In a European market with free trading of goods it is of utmost importance that especially those (socially deprived) women in most need of folic acid, are reached. A common European decision for/against fortification should be considered. Public Health ethics demand not only good evidence for the benefit, but also a good estimation of the (potential) risks. Due to a paucity of good risk estimation, no European country has plans to decide in favour of an obligatory fortification on its own.